Online Books > American College of Physicians Home Care Guide for Cancer

Maintaining Positive Experiences

Understanding the Problem

Why it is important to keep up positive experiences during an illness

How this protects against depression

People caring for someone with cancer should keep up positive experiences, too

When To Get Professional Help

If the person with cancer feels it is impossible to have positive experiences, read the home care plan for Coping with Depression for guidance about when to get professional help

What You Can Do To Help

Three types of positive experiences

How to pay more attention to positive experiences

How to arrange and organize positive experiences

A place to list pleasant, involving activities that the person with cancer can do now

Possible Obstacles

"Nothing is pleasant anymore."

"You can't do anything about the bad things that happen when you're sick."

"There are too many problems for the family caregiver to find time for pleasant activities."

The family caregiver feels guilty about doing enjoyable things when the person with cancer is sick.

Carrying Out and Adjusting Your Plan

Set deadlines to plan and have positive experiences

Be sure your goals are reasonable

Ask other people for suggestions

Examples of Positive Activities and Experiences

(Topics with a in front of them are actions you can take or symptoms you can look for.)

People with cancer tend to focus their attention on their problems. As a result, they may withdraw from the people and activities they normally enjoy. For example, they may stop seeing friends or lose interest in a favorite hobby, and the quality of their lives may suffer.

Pleasant, satisfying experiences help people cope with cancer and other serious problems. Having fun makes people feel better physically and emotionally. When people regularly do things they enjoy, they keep a positive outlook on life and are less likely to become depressed during a difficult illness like cancer.

One of the most important things a caregiver can do for the person with cancer is to help that person find a balance between his or her problems and the enjoyable things in life.

Your goal is to arrange as many pleasant, positive experiences as possible for the person with cancer during this illness.

(Persons caring for someone with cancer can also become preoccupied with their problems. They should remember to do things they enjoy, too, in order to maintain a positive outlook. Caregivers who think only about the needs and problems of the person with cancer are likely to become upset and discouraged. As a result, they may no longer give their best care. Caregivers should read this plan for themselves as well as for the persons under their care.)

If the person with cancer feels that it is impossible for him or her to have any positive experiences, and, at the same time, is feeling sad and depressed, then professional help is needed.

Read the home care plan on Coping with Depression for guidance about when and how to get professional help for depression.

There are three types of positive experiences that are important in maintaining good quality of life and in helping prevent depression.

Enjoyable activities with other people: doing things with people who like and respect you and whom you enjoy being with. Examples are:

• Talking about sports with a friend

• Shopping with a friend

• Going to the beach with the family

• Calling a friend on the phone

• Being in a play

• Going to a party

• Playing cards with friends

• Playing with grandchildren

• Gossiping with friends

• Going to church with family

• Singing in a choir

• Attending a fraternal organization or service club meeting

Important activities that give the person a sense of accomplishment: activities that he or she feels are important and that give them a sense of pride. Examples are:

• Cooking a fancy meal

• Building a snowman

• Repairing a broken lamp

• Starting a new hobby

• Jogging

• Solving a crossword puzzle

• Writing a letter

• Volunteering to help needy people

• Playing a musical instrument

• Restoring old furniture

• Cleaning the stove

• Writing a poem

Activities that make the person feel good: doing things or thinking about things that are especially pleasant and that lead to feelings that are the opposite of feeling depressed. Examples are:

• Watching a favorite TV program

• Watching a funny movie

• Taking a ride in the country

• Listening to a favorite kind of music

• Reading a favorite magazine

• Walking along the shore

• Hugging someone you love

• Eating a special food

• Saying a prayer

• Playing with a pet

• Going to a religious service

• Reading a joke book

There are two things you can do to ensure that the person with cancer has these three types of positive experiences.

1. You can help him or her pay attention to positive things that happen.

2. You can arrange and organize pleasant activities.

Talk about pleasant experiences as they happen during the day.

It is easy to notice and think just about unpleasant experiences when you are under stress. When this happens, it can make you and the person with cancer depressed. Make a point of noticing and talking about pleasant things as they happen; this helps to keep a balance between pleasant and unpleasant experiences.

Set aside a special time each evening when you and the person with cancer talk about the good things that happened that day.

Think back over the day and talk with the person with cancer about everything that was pleasant. Be sure to include all three categories: pleasant things that happened with other people, activities that gave a sense of pride and accomplishment, and activities that made him or her feel good.

Make lists of pleasant experiences.

This is helpful to many people because the pleasant experiences seem more definite or real when they see them written down.

Keep these lists and read them over from time to time to remind him or her about the good things in life. After you have done this for awhile, you both will find yourselves noticing good things as they happen and telling yourselves "I'll write that down tonight." And, best of all, you'll start the day looking forward to the positive things that will happen.

Make a list of activities that have been pleasant and enjoyable in the past.

You should do this with the person with cancer as well as with other family members and friends who have done pleasant activities with him or her. Be imaginative-think of as many activities as you can for each category. Include activities that have been pleasant during the illness as well as before the illness.

Decide what part of the activities the person with cancer can do now.

Some of the activities won't require any changes, but others may have to be changed because of limitations due to the illness. If you need to change an item, erase it and write what the person with cancer can do now in its place.

If the person with cancer can't do an activity, ask yourself:

• Can he or she do some part of it?

• Can he or she do something similar to that activity?

• Can he or she talk about how to do that activity after the illness or treatments are over?

Further down this page is a list of activities that other people have found enjoyable and rewarding. If you are having trouble remembering pleasant activities, this list may remind you.

The following is an exercise to help you list pleasant, enjoyable activities that the person with cancer can do now. We recommend that you do the exercise now and that you add to it throughout the illness. Then your list will be ready to use whenever you need it.

Include all three types of pleasant activities:

• enjoyable activities with other people,

• activities that give a sense of pride and accomplishment, and

• Acctivities that make the person with cancer feel good.

First, write activities for each category that the person with cancer has enjoyed in the past. Then write what part of those activities he or she can do now.

• Enjoyable activities with other people

• Activities with a sense of accomplishment

• Activities that make him or her feel good

Here are examples of how past activities can be adjusted so that the person with cancer can do part of them or something like them now.

(Past activities are in regular type and activities the person with cancer can do now are in italic type.)

Enjoyable activities with other people:

Shopping with friends - Go through catalogs with Ann and Thelma
Playing cards - Invite Bill and Ann to play cards
Dinner with John and Kay - Invite John and Kay for dessert
Watch grandson play baseball - Watch baseball on TV with grandson

Important activities that give a sense of accomplishment:

Cleaning basement - Clean room
Finishing jigsaw puzzle - Start new puzzle
Grass mowing - Arrange to pay Billy to mow grass
Sailing - Build a model sailboat

Activities that make him or her feel good:

Fred Astaire movies - Rent video
Cosby TV program - Watch for reruns
Dixieland jazz - Play records after supper
See grandchildren grow up - Look through picture album

See the list at the end of this home care plan for more examples of activities that other people have found enjoyable and rewarding.

To make your plan work, you need to consider obstacles that could prevent you from carrying out your plan.

1. Person with cancer says, "No activity is pleasant anymore."

Response: No matter how depressed or upset someone is, there are always some activities and thoughts that are pleasant-even if it is only for a short time. Start by noticing the good things that happen each day-even if they are small. Make lists of good things at the end of the day. Then try planning different activities until you find something that he or she responds to. It may be slow going at first but keep trying. You will often find that the person gradually becomes more and more responsive. If the person with cancer is very depressed, he or she may need professional help. Read the home care plan on Coping with Depression for ideas about what you can do to help control depression and about when to get professional help for depression.

2. "When you are sick, a lot of things happen that you wish wouldn't happen-but you can't do anything about them."

Response: This home care plan will help you to balance your positive and negative experiences. We can't do anything about many of the negative experiences due to an illness, but we can balance them with positive experiences -- that is what this care plan will help you to do.

3. "There are so many problems to deal with that the family caregiver can't find time for pleasant activities."

Response: Family caregivers need to keep up pleasant activities as much as the person with cancer. Pleasant activities are especially important for people who are under stress! That is when they are needed the most. You need to make time for pleasant experiences, even in the midst of problems. If you just think about problems, you and the person with cancer will become sad and depressed.

4. The person caring for someone with cancer says, "I feel guilty if I enjoy myself when the person I'm caring for feels sick and needs my help."

Response: You should be scheduling pleasant experiences for yourself as well as for the person you are caring for. You will be a better caregiver if you are in good spirits and doing things you enjoy. If you are depressed, you won't be able to do your best as a caregiver. Therefore, scheduling pleasant experiences for yourself is part of being a good caregiver.

What additional road blocks could get in the way of doing the things recommended in this home care plan? For example, will the person with cancer cooperate? Will other people help? How will you explain your needs to other people? Do you have the time and energy to carry out the plan?

You need to develop plans for getting around these road blocks. Use the four COPE ideas (creativity, optimism, planning, and expert information) in developing your plans. See the chapter on Solving Home Care Problems at the beginning of the book for a discussion of how to use the four COPE ideas in overcoming your obstacles.

Start now

Don't wait until the person with cancer is depressed or feeling overwhelmed by problems. Start using this home care plan right away and then continue to use it throughout the illness. Start by noticing positive things as they happen. Then make lists of good things that happen at the end of the day, and, finally, schedule pleasant activities to do each week. Scheduling pleasant activities is one of the best ways to protect against depression.

Set deadlines

If you don't set deadlines to do these things, problems will push them aside. Therefore, you should decide, with the person with cancer, when you will do each of the activities you listed.

Your lists of good things that happen each day are a record of your progress. If the number or types of good things change, ask yourself why.

Don't be discouraged if you are not completely successful the first week. As you get more experience, you will get better and better at planning and noticing positive experiences. Ask yourself if your goals were reasonable. Perhaps you set goals that were too ambitious.

Ask other people to make suggestions for pleasant activities for the person who has cancer. Other experienced caregivers may have good ideas. Social workers and nurses who work with cancer patients often have good suggestions. Be creative. Try unusual and new ideas.

Enjoyable things that happened with other people: Jerry said I looked good today; Martha went out of her way to get my medicine; the nurse was very understanding about how I felt; Tom did the dishes without complaining; Mary and I had a good talk; Bill and I talked about the old days.

Activities that gave a sense of accomplishment: I beat Charlie at chess; I stood up to the parking attendant and told him he was being rude; I finished knitting the arm to the sweater; I cleaned out my bureau drawers; I balanced the checkbook; I finished potting the flowers; I walked farther than I did yesterday.

Activities that make me feel good: I saw a bluebird; I enjoyed the shadows that the sun made coming through my window; I really laughed at the interview with the lobster fisherman on the evening news; I looked through our family album; I went to church; I ordered flowers for Ann, who is in the hospital; I encouraged Bill, who was just diagnosed with cancer.

Doing things with other people: calling a friend on the phone, playing cards with friends, going to a party or social affair where there are people you like to be with, working on a project with a friend or family member.

Doing important, rewarding activities: working on a home improvement project, doing volunteer work, helping someone else.

Doing things that make you feel happy: watching a funny movie, hugging someone you love, watching people being happy, gardening, sports, walking, hobbies.

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